Objective The study aimed to construct and validate a predictive model for pulmonary nodules(PN)nature based on clinicopa-thological features,imaging,and serum biomarkers,so as to provide scientificdecision-making for early diagnosis and treatment of lung cancer.Methods A retrospective was performed on 816 PN patients with definited pathological diagnosis who received surgical resection analysisor lung biopsy in the Department of Thoracic Surgery and Oncology of Shenzhen Traditional Chinese Medicine Hospital from January 2019 to February 2023.Among them,113 cases that did not meet the inclusion criteria were excluded,and the remaining 703 cases were included in the study.The study based on the clinicopathologic features(age,gender,smoking history,smoking cessation history and family history of cancer),chest imaging(maximum diameter of nodule,location of lesion,clear border,Lobulation,spiculation,vascular convergence sign,vacuole,calcification,air bronchial sign,emphysema,nodule type and pleural indentation,nodule number)and serum carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CYFRA21-1),squamous cell carcinoma antigen(SCCA)in patients with PN.These cases were randomly divided into a modeling group(n=552,237 benign,315 malignant)and a validation group(n=151,85 benign,66 malignant).First,univariate analysis was performed to screen for statistically significant predictors of nodules nature.Then,multivariate regression analysis was performed to screen for independent predictors of nodules nature.Finally,the prediction model of PN nature was constructed by logistic regression analysis.Subsequently,the validation group data were entered into the proposed model and Mayo clinic(Mayo)model,veterans affairs(VA)model,Brock University(Brock)model,Peking University(PKU)model and Guangzhou Medical University(GZMU)model,respectively.PN malignancy probability was calculated.The receiver operating characteristic(ROC)curves were plotted.The diagnostic efficiency of each model was compared according to the area under the curve(AUC).Results There were statistically significant variables including age,family history of cancer,maximum nodule diameter,nodule type,upper lobe of lung,calcification,vascular convergence sign,lobulation,clear border,spiculation,and serum CEA,SCCA,CYFRA21-1 using univariate analysis.Multiple regression analysis showed that age,CEA,clear border,CYFRA21-1,SCCA,upper lobe of lung,maximum nodule diameter,family history of cancer,spiculation and nodule type were independent predictors of PN nature.The prediction model equation constructed in this study is as follows:f(x)= ex/(1+ex),X=(-6.318 8+0.020 8×Age+0.527 4×CEA-0.928 4×clear border+0.294 6×Cyfra21-1+0.294×maximum nodule diameter+1.220 1×family history of cancer +0.573 2×upper lobe of lung +0.064 8×SCCA +1.461 5×Spiculation +1.497 6×nodule type).The AUC(0.799 vs 0.659,0.650)of the proposed model was significantly higher compared with Mayo model and VA model,and there were statistically significant differences(Z=3.029,2.638,P=0.003,0.008).However,compared with Brock model,PKU model and GZMU model,the differences of AUC(0.799 vs 0.762,0.773,0.769)were not statistically significant(Z=1.063,0.686,0.757,P=0.288,0.493,0.449).Conclusion The prediction model for PN nature established in this study is accurate and reliable,which can help clinics with early diagnosis and early intervention,and this prediction model deserves to be popularized.

OBJECTIVE: To analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications. METHODS: A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed. RESULTS: Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra ( r=0.493, P<0.001). CONCLUSION The incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.
Male ; Female ; Humans ; Aged ; Kyphoplasty/methods* ; Bone Cements ; Fractures, Compression/surgery* ; Spinal Fractures/surgery* ; Retrospective Studies ; Osteoporotic Fractures/etiology* ; Treatment Outcome ; Vertebroplasty/methods*

OBJECTIVE: To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture. METHODS: A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T ₁₀-L ₂, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation. RESULTS: Except LL ( P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX ( P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated ( P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively. CONCLUSION Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.
Male ; Female ; Humans ; Aged ; Fractures, Compression/surgery* ; Spinal Fractures/diagnostic imaging* ; Lumbar Vertebrae/surgery* ; Thoracic Vertebrae/surgery* ; Kyphosis/surgery* ; Osteoporotic Fractures/surgery* ; Lordosis ; Tomography, X-Ray Computed ; Retrospective Studies

ObjectiveTo explore sleep disturbance in preschool children with autism spectrum disorder (ASD) and analyze the relationship between sleep disturbance and social behavior. MethodsFrom December, 2020 to December, 2022, 221 preschool children with ASD from Beijing Bo'ai Hospital and other two institutes, and 246 healthy preschool children socially recruited were investigated with Children's Sleep Habits Questionnaire (CSHQ). A total of 47 ASD children and 47 healthy children were selected from them to wear a sleep monitoring watch for seven days, while the ASD children were evaluated with Gesell Development Diagnosis Scale (GDDS), Psychoeducational Profile-Third Edition (PEP-3), Autism Diagnostic Observation Schedule-2 (ADOS), Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS) and Social Responsiveness Scale (SRS). ResultsAll the factor-scores were more in the ASD children than in the healthy children (t > 2.491, P < 0.05), except that of daytime sleepiness. The prevalence of sleep disturbance (CSHQ ≥ 41) was 89.6% in ASD children, which was more than that of the healthy children (76.8%) (χ² = 13.360, P < 0.001). The sleep problems in ASD children included bedtime resistance, sleep anxiety, sleep duration, sleep onset delay, parasomnias and sleep disordered breathing. ASD children were shorter in total bedtime, shorter in total sleep time, longer in sleep latency, longer in awake time and lower in sleep efficiency (|t| > 2.001, P < 0.05), compared with those of healthy children. For ASD children, the total bedtime negatively correlated with GDDS-language, PEP-3-expressive language, PEP-3-communication and PEP-3-maladaptive behaviors (r < -0.300, P < 0.05); the sleep efficiency negatively correlated with total score of CARS (r = -0.365, P < 0.05); sleep latency correlated with GDDS-social, PEP-3-cognitive, PEP-3-expressive language, PEP-3-receptive language, PEP-3-visual-motor imitation, PEP-3-characteristic verbal behaviors, PEP-3-communication, original score of ADOS, ADOS-social affect, and total score of CARS (|r| > 2.90, P < 0.05); and total awake time positively correlated with total score of CARS (r = 0.406, P < 0.05). ConclusionSleep disturbance is prevalent and various in preschool ASD children, and influence their social behaviors.

Objective:To explore the efficacy and safety of camrelizumab combined with apatinib as the second-line treatment for patients with advanced gastric cancer.Methods:The clinical data of 19 patients with advanced gastric cancer in Hebei General Hospital from August 2019 to March 2022 were retrospectively analyzed. All patients received camrelizumab combined with apatinib as the second-line treatment. The treatment efficacy and adverse reactions were evaluated; the survival analysis was performed using Kaplan-Meier method; Cox proportional hazards model was used to analyze the influencing factors for overall survival (OS) of patients.Results:Among 19 patients, no one achieved complete remission, 4 patients (21.1%) achieved partial remission, 9 patients (47.4%) had stable disease. The objective response rate (ORR) and disease control rate (DCR) were 21.1% (4/19) and 68.4% (13/19), respectively. The ORR of patients with deficient mismatch repair (dMMR) was higher than that of patients with proficient mismatch repair (pMMR) [100.0% (2/2) vs. 11.8% (2/17), P < 0.05], and patients with programmed death receptor ligand 1 (PD-L1) combined positive score (CPS) ≥1 had a higher DCR than patients with PD-L1 CPS < 1 [100.0% (5/5) vs. 25.0% (1/4), P < 0.05]. The median follow-up time of 19 patients was 14.7 months (12.0-17.4 months), the median progression-free survival time and OS time were 2.8 months and 5.7 months (95% CI 2.4-8.9 months). Increased lactate dehydrogenase (LDH) was negatively correlated with OS ( χ2 = 10.262, P = 0.001). Multivariate Cox regression analysis showed that LDH was an independent influencing factor for the OS of patients (<250 U/L vs. ≥250 U/L: HR = 0.149, 95% CI 0.039-0.657, P = 0.005). The most common treatment-related adverse reactions were fatigue (52.6%, 10 cases), anemia (47.4%, 9 cases), thrombocytopenia (36.8%, 7 cases), rash (36.8%, 7 cases), and reactive capillary hemangioma (36.8%, 7 cases). Conclusions:Camrelizumab combined with apatinib as the second-line treatment for advanced gastric cancer have good efficacy and safety.

ObjectiveTo investigate the impacts of circadian misalignment on glucose uptake of skeletal muscle and metabolism in rats. MethodsA total of 36 male Wistar rats were divided into circadian alignment (CA, normal light-dark cycles, n = 18) and circadian misalignment (CM, shifted light-dark cycles, n = 18) groups. ClockLab behavior analysis was performed for 18 days (61 to 78 days after modeling). Intraperitoneal injection glucose tolerance test and physiologic measures were performed 85 days after modeling. They were euthanized 91 to 92 days after modeling, at 8:00, 12:00, 16:00, 20:00, 24:00 and 4:00 next day. Gastrocnemius tissue was collected and measured for Bmal1, Clock, Per2, Tbc1d1, Glut4 and Pgc1α by reverse transcription real-time quantitative polymerase chain reaction (RT-qPCR). ResultsThe circadian cycle increased (t = -6.557, P < 0.001), the amplitude decreased (t = 2.326, P = 0.030) and the area under curve (AUC) of the blood glucose of intraperitoneal glucose tolerance test decreased (t = -2.622, P = 0.016) in CM group. In gastrocnemius, there was difference in the expression of the Bmal1 (F = 6.691, P < 0.001), Clock (F = 4.188, P = 0.007), Per2 (F = 10.893, P < 0.001), Tbc1d1 (F = 3.411, P = 0.018), Glut4 (F = 5.439, P = 0.002) and Pgc1α (F = 15.376, P < 0.001) across different time; meanwhile, there was difference in the expression of Bmal1 (F = 5.020, P = 0.035), Per2 (F = 8.996, P = 0.006), Tbc1d1 (F = 51.111, P < 0.001) and Pgc1α (F = 10.177, P = 0.004) between groups, and the total Tbc1d1 expression decreased in CM group (t = 4.349, P < 0.001). ConclusionCM induced by shifted light-dark cycles may lead to glucose tolerance impairment in rats, which may be related to the decreased expression of Tbc1d1 and the changes of transcription rhythm of Bmal1, Per2 and Pgc1α in gastrocnemius.

OBJECTIVE: To explore the molecular basis of two individuals with weak D variant of the Rh blood type. METHODS: Routine serological testing was carried out to detect the D, C, c, E and e antigens of the Rh blood group. The D antigen was further detected with an indirect antiglobulin test. The presence of Rhesus box was detected by PCR to determine the homozygosity of the RHD gene. RESULTS: Both samples were determined as weak D phenotype by the indirect antiglobulin test. DNA sequencing revealed that case 1 harbored a heterozygous 208C>T variant in exon 2 and a heterozygous 1227G>A variant in exon 9; while case 2 harbored homozygous 779A>G variants of exon 5 of the RHD gene. Case 1 was determined as RHD+/RHD+, while case 2 was determined as RHD+/RHD-. The two samples were respectively named as weak D type 122 and weak D type 149 based on the rules of Rhesus Base Nomenclature. CONCLUSION D negative blood donors should subject to indirect antiglobulin testing and molecular analysis for safer transfusion.
Alleles ; Blood Donors ; Blood Grouping and Crossmatching ; Genotype ; Humans ; Molecular Biology ; Phenotype ; Rh-Hr Blood-Group System/genetics*

Objective:To explore the quantitative analysis value of diffusion tensor imaging (DTI) for early changes of calf muscle in type 2 diabetes mellitus (T2DM) patients without peripheral ischemia.Methods:From September 2018 to March 2019, 20 male T2DM patients (age: 45-64 years) without peripheral ischemia and 20 matched male healthy controls (age: 46-62 years) who performed lower limb DTI in Wuxi Second Hospital Affiliated to Nanjing Medical University were prospectively analyzed. Fractional anisotropy (FA), apparent diffusion coefficient (ADC) and λ 1, λ 2, λ 3 values of medial head of gastrocnemius (GM), lateral head of gastrocnemius (GL), tibialis anterior(TA) and soleus muscles(SOL) were measured respectively. The differences of DTI diffusion characteristics between 2 groups were compared by using independent-sample t test, and the correlation between FA, ADC and body mass index (BMI), fasting blood glucose (FBG), hemoglobin A 1c (HbA1c), high density lipoprotein (HDL), low density lipoprotein (LDL) and triglyceride (TG) were analyzed by Pearson correlation analysis. Results:The ADC of TA and SOL in T2DM group ((1.77±0.15) and (1.83±0.10)×10 -3 mm 2/s) was higher than that in control group ((1.66±0.11) and (1.75±0.16)×10 -3 mm 2/s); λ 1, λ 2, and λ 3 of TA in the T2DM group ((2.30±0.21), (1.63±0.17) and (1.38±0.13)×10 -3 mm 2/s) were higher than those in control group ((2.17±0.12), (1.51±0.13) and (1.31±0.12)×10 -3 mm 2/s); λ 2 and λ 3 of SOL were also higher than those in control group ((1.74±0.11) vs (1.64±0.18)×10 -3 mm 2/s and (1.53±0.12) vs (1.44±0.15)×10 -3 mm 2/s; t values: 2.65-3.91, all P<0.05). There were no significant correlations between FA, ADC and BMI, FBG, HbA1c, HDL, LDL and TG ( r values: from -0.15 to 0.08, all P>0.05). Conclusions:Quantitative parameters of DTI, especially ADC, can sensitively detect the microstructural changes of calf muscle in T2DM patients without peripheral ischemia. TA and SOL have high sensitivity to the diffusion of T2DM-related microstructural changes.

Objective To analyze the effects of different therapies on patient survival,to explore the related prognostic factors in elderly patients with advanced gastric cancer,and to provide recommendations for the treatment of such patients.Methods Retrospective analysis was conducted on 146 elderly patients with advanced gastric cancer hospitalized from January 2009 to October 2013 in Yixing People's Hospital of Jiangsu Province.Detailed clinical data were recorded,and patients were followed up during the total survival time.Univariate analysis with the Log rank test and multivariate analysis with the COX proportional hazard model were utilized to examine the related prognostic factors in elderly patients with advanced gastric cancer.Results The 1-,2,3-year survival rates of t46 elderly patients with advanced gastric cancer were 33.6 ％,11.0 ％,and 2.1 ％,respectively,and the median survival time was 10.3 months.The Log-rank test showed that Karnofsky (KPS) score,differentiation degree,number of metastatic sites,malignant serous effusion,chemotherapy,and traditional Chinese medicine (TCM) were associated with the prognosis of elderly patients with advanced GC (all P＜0.05).Multivariate analysis by the COX proportional hazard model showed that KPS score (HR=1.575,95％ CI:1.094 2.267,P=0.015),differentiation degree (HR=0.499,95％CI:0.340-0.732,P＜0.001),malignant serous effusion (HR=0.516,95％ CI:0.356-0.748,P＜ 0.001),chemotherapy (HR=1.669,95％ CI:1.185 2.351,P=0.003),and TCM (HR=1.793,95％ CI:1.237-2.600,P=0.002) were independent factors related to the prognosis of elderly patients with advanced GC.Conclusions The prognosis of elderly patients with advanced gastric cancer is poor,especially for patients with a low KPS score,a poor differentiation degree,or malignant serous effusion.Chemotherapy and TCM can improve the prognosis.

Objective:To establish a method for the simultaneous determination of 8 heavy metal elements Pb, Cd, As, Hg, Co, V, Se and Mo in iron dextran by inductively coupled plasma optical emission spectrometry ( ICP-OES) . Methods:Through the detec-tion wavelength selection,the detection wavelength was confirmed as follows:220. 353 nm for Pb, 228. 802 nm for Cd, 188. 980 nm for As, 194. 164 nm for Hg, 228. 615 nm for Co, 311. 070 nm for V, 196. 026 nm for Se and 204. 598 nm for Mo. Through optimizing the instrument parameters, the optimal radio frequency power was 1. 3 kW, the nebulizer gas flow rate was 0. 7 L·min-1, and the pump speed was 10 r·min-1. By applying the above detection parameters, the 8 heavy metal elements were analyzed by ICP-OES simultaneously. Results: The linearity of the detected elements was good, and the correlation coefficients were all greater than 0. 9990. The detection limits were from 0. 12 to 7. 26 ng·ml-1 , the quantitation limits were from 0. 40 to 23. 96 ng·ml-1 and the recoveries were from 94. 1% to 103. 4% (RSD<3%, n=9). Conclusion: The method is specific, sensitive, rapid and accurate, which can be applied in the simultaneous determination of 8 heavy metal elements in iron dextran.